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Your Lung Operation Booklet

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1 AMERICAN COLLEGE OF SURGEONS DIVISION OF EDUCATION SURGICAL PATIENT EDUCATION Table of Contents Welcome ...................................................................................1 Your Lungs ...............................................................................2 Lung Cancer ...........................................................................3 SURGICAL Understanding Your Operation ........................................4 PATIENT Preoperative Tests ................................................................5 EDUCATION Home Preparation ................................................................8 The Day of Your Operation ...............................................13 After Your Operation ..........................................................14 Your Recovery and Discharge .........................................17 When to Call Your Doctor .................................................19 Welcome You and your family are important members of the surgical team. The American College of Surgeons (ACS) “Your Lung Operation: Education for a Better Recovery” program will help you prepare for your operation and recovery. You and your family will know what to expect. You will learn how to work with your surgical team to ensure that you have the best surgical outcomes. COMPLETE THE “YOUR LUNG OPERATION” EDUCATION PROGRAM: Watch the DVD Read the booklet Review the Medication List and Quit Smoking Resources (inside front cover) Complete the Activity Log (inside front cover) Send us your evaluation after your postoperative visit or 2 to 3 weeks after your operation (inside back cover) THIS PROGRAM WILL HELP YOU UNDERSTAND: ● Your lungs and the type of operation you may need ● The tests and home preparation needed weeks before your operation ● How your surgical team (including you) will work to ensure the best recovery while you are in the hospital and at home www.facs.org/patient education • YOUR LUNG OPERATION • EDUCATION FOR A BETTER RECOVERY 2 Your Lungs Who Needs a Lung Operation? The main reason for having an operation on your lung is to remove a lung nodule or tumor. Other reasons include: ● An abnormal X ray ● Treatment of infection or scarring around the lung ● Removal of sections of the lung that are diseased Understanding Your Respiratory System Knowing how your lungs work is helpful in understanding your operation. Trachea YOUR LUNGS When you take a breath, air and oxygen Right Lung Left Lung pass from your mouth and nose through your trachea (windpipe) and right and left bronchus and into your lungs. Your lungs carry the oxygen through small tubes called bronchioles, and then to the alveoli. The alveoli are where the oxygen meets with the bloodstream. Oxygen is provided to the blood, and carbon dioxide is released back into the Mediastinum Heart (area between lungs) alveoli. As you breathe out, the carbon dioxide gas exits through your lungs and then out through your mouth. Trachea LUNG LOBES Lymph Nodes The lungs are divided into lobes. There are 3 lobes on your right side Right Upper Lobe and 2 lobes on your left side. Left Upper Lobe LYMPH NODES NEAR Left Bronchus Right Bronchus THE LUNGS Bronchioles The lungs also have a large supply of lymph nodes. The lymph Right Middle Lobe nodes are small, round masses Left Lower Lobe of tissue that filter the blood and Right Lower Lobe trap cancer cells and bacteria. AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION • PARTNERS IN YOUR SURGICAL CARE© Lung Cancer 3 Understanding Lung Cancer Staging If you are having this operation to remove a lung tumor, you will need to know a little more about the staging of lung cancer. LUNG CANCER CELLS Lung cancer starts in the cells lining your lungs. Cancer cells grow faster and look abnormal in comparison with your healthy cells. The cancer cells continue to grow and eventually can be seen as a tumor on imaging tests. The cancer cells can spread (metastasize) to other parts of the lung and body. The stage of your cancer is determined by the size of the tumor and if there is spread to other areas. These areas include nearby lymph nodes and the mediastinum (area between the lungs). YOUR CANCER REPORT On your cancer report, you Lymph nodes may also see the letters TNM. Stage I Stage III These are the letters used for cancer staging. They mean: T: Tumor size N: Nearby lymph nodes M: Metastasized or spread to other organs of the body CANCER STAGE: NON– SMALL-CELL LUNG CANCER Stage I. The tumor is in Stage III. The tumor size is more the lung only and has not than 7 cm. It has spread to the The stages for non–small-cell spread to the lymph nodes. lymph nodes outside of the lung. lung cancer range from I, where It is 3 cm or less in size. For Stage IIIA, the cancer remains on there are some abnormal cells the same side as the original tumor. lining the airway, to stage IV, where the tumors have spread For Stage IIIB, the tumor has to other organs of the body. Stage II spread to lymph nodes above the collarbones or to the opposite side of the chest. The tumor can also be growing into the space between the lungs, the heart or large blood vessels, the trachea, and the esophagus. For more information on Stage IV. The tumor has spread cancer staging, please visit to other parts of the body, such the CancerCare website as the liver, bones, or brain. at http://www.lungcancer. Stage II. The tumor has spread org/reading/staging.php. to lymph nodes within the same lung. The tumor size is between 3 to 7 cm and may be blocking airways. www.facs.org/patient education • YOUR LUNG OPERATION • EDUCATION FOR A BETTER RECOVERY 4 Understanding Your Operation Your Operation: Removing a Section of Your Lung There are different approaches that your surgeon can do to remove part of your lung. The approach is based on the location and extent of your disease, the surgeon’s level of expertise, and your overall health. Wedge Resection: Segmentectomy: A small, pie-shaped section from a lung lobe is removed. Each lobe contains between 2 and 5 segments. A segmentectomy removes one or more segments but less than the entire lobe. Lobectomy: Pneumonectomy: An entire lobe is removed. The rest of the An entire lung is removed. The sac that contained lung inflates to fill up the space. the lung (pleural space) fills with fluid. AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION • PARTNERS IN YOUR SURGICAL CARE© 5 Your Operation: Surgical Approach VIDEO-ASSISTED THORACIC THORACOTOMY OTHER SURGICAL SURGERY (VATS) A 3- to 8-inch incision is made on your PROCEDURES For a VATS procedure, 2 to 4 small chest. It can extend from under your On rare occasions, your surgeon may incisions are made on the chest. Each arm around to your back. Some muscle decide to go in through the middle incision is about 1 to 3 centimeters is cut, and the ribs are spread apart. of your chest (median sternotomy). in length. Surgical tools and a Occasionally a small portion of the rib This approach may be used to reach thoracoscope (tube with a video must be removed to allow access to both right and left lungs, as well as camera and light source) are placed the lung. Sometimes smaller incisions lymph nodes in the mediastinal area. in the incisions. The lung tissue is cut under or near the armpit can be used away and placed in a small bag and for this procedure. This procedure is then removed through an incision. called a mini-thoracotomy. The size Nonsurgical Approach and location of the incision depends For patients who cannot have on the part of the lung being removed. an operation due to other medical conditions, stereotactic radiation therapy or other removal techniques may be an option. www.facs.org/patient education • YOUR LUNG OPERATION • EDUCATION FOR A BETTER RECOVERY 6 Preoperative Tests Preparation for your lung operation is important and can take time. It involves many tests, procedures, and discussions with your surgeon about your care and possible enrollment in clinical trials. There are also things you need to start doing at home weeks before your operation. MAGNETIC RESONANCE IMAGING (MRI) Tests and Procedures A MRI uses radio waves and a magnetic field to get These tests help identify your current pulmonary detailed images of body organs. A brain MRI is the (lung) function, the extent of your disease, most sensitive test to detect brain metastasis. and your overall state of health. Tests may include: ● Complete history and physical ● Blood test ● Urinalysis ● EKG ● Scans (CT, MRI, PET) ● Chest X ray ● Pulmonary function test Pulmonary Function Test (PFT) A PFT measures the amount of air that you can breathe in and how much oxygen gets into your bloodstream. You usually shouldn’t eat or smoke for 4 to 6 hours before the test. Also, let your doctor know if you are using any inhalers. Scans COMPUTERIZED TOMOGRAPHY (CT) SCAN A CT scan is a special X ray that takes detailed cross-sectional images of the chest. POSITRON EMISSION TOMOGRAPHY (PET) SCAN A PET scan uses a small amount of tracer injected into a vein. The scan then measures the amount of tracer absorbed by certain organs or tissues. Often a combined CT/PET scan is used to estimate if the tumor has spread. AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION • PARTNERS IN YOUR SURGICAL CARE© 7 MEDIASTINOSCOPY Types of Lung Biopsy Procedures A scope is inserted between the lungs in a small incision Your surgeon will determine if you need a biopsy made above the breastbone or alongside the breastbone. (tissue sample). Sometimes a biopsy is done during the Tissue and/or lymph nodes are removed through the scope. operation. After the biopsy, the tissue sample is viewed under a microscope and checked for cancer cells. Sedation medication to help you relax or sleep is given before many of these procedures. You will need someone available to drive you home if sedation is used. BRONCHOSCOPY A scope (thin tube with a light source on the end) is placed through your mouth or nose and into your trachea and large airways.
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